What is Lichen Sclerosus?

Lichen Sclerosus is a relatively uncommon inflammatory, dry, pruritic (itchy) disease of the skin and mucous membranes. Lichen Sclerosus is characterized by distinctive papules which may be as small as a pinhead or larger. Lichen sclerosus is an uncommon skin disorder of unknown cause. Lichen sclerosus (LS) is thought to be more common in women than men. It can start at any age, although it is most often seen in women over 50. It may be unnoticed by the affected person but it can be itchy, sometimes severely so. When it occurs on the body, LS usually results in white spots on the shoulders. They have a curious tissue paper-like wrinkled surface with a waxy thickened feel. 

 

Lichen Sclerosus in Women  

It is most common for LS to occur on genital skin. In women this results in a white thickened vulva. Sometimes the vulva becomes smaller and the vagina tightens. When the anal skin is involved there may be discomfort passing bowel motions. The skin may split, especially if there is a tendency to constipation. It can be unbearably itchy. Sometimes blood blisters and sores appear, after scratching, or on their own. Thrush (candida) and other infections are often present, and intercourse can be very uncomfortable.

 

Lichen Sclerosus in Men  

In men, the usual site for LS is the tip of the penis, which becomes firm and white. The urethra may narrow such that it is difficult to pass urine, resulting in a thin stream. Sometimes the passage has to be widened with a special operation, called meatal dilation. The foreskin may be come difficult to retract (phimosis) and a circumcision may be needed.

 

   

 

What Causes Lichen Sclerosus?

The cause is often unclear. The exclusion of causative drugs and chemicals is essential before making the diagnosis of LS. Some patients complain of emotional stress. The differential diagnosis is long and includes psoriasis, discoid lupus erythematosus, and lichen planus. When in doubt, a biopsy may help. The histopathology (microscopic features) of LS is diagnostic in most cases.

 

How is Lichen Sclerosus treated?

Local symptomatic treatment may be achieved with corticosteroid creams, ointments, or sprays, along with colloidal baths. Antihistamines may give relief for itch. It is important to follow the instructions outlined in Dr. Jacobs’ educational handout on dry and sensitive skin. When there is widespread involvement with limited lesions, topical steroids may produce prompt involution of the lesions.  Testosterone cream can help in most cases of lichen sclerosus.

What can you expect?

LS is a chronic skin condition. There may be no good treatment to shorten the course of the disease. LS usually lasts for years before resolving spontaneously, but it may distort the shape of the genitals permanently. Treatment varies. Strong topical steroid creams are helpful, applied very accurately to the affected areas for a few weeks, with milder creams afterwards. Infection present may need treating.  LS may be associated with increased risk of vulval cancer. It is recommended that a specialist interested in conditions affecting the vulva follow women up long term. This is especially true of severe forms of LS. After the lesions have disappeared, deep pigmentation may persist for many months. Less often, depigmented atrophic (thin) spots may remain. There are usually no other systemic complications except the slight danger of development of squamous cell carcinoma in vulvar lesions. For this reason, female LS patients should visit their gynecologist or dermatologist regularly and male patients should see the dermatologist on a regular basis.